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Analysis of electrocardiograms for subcutaneous monitors
Martin C Burke1, Zhendong Song, Janice Jenkins
1Department of Medicine/Cardiology, Loyola University Medical Center, Maywood, IL 60153, USA. mburke4@lumc.edu
Journal of Electrocardiology
|January 13, 2004
Summary
Subcutaneous cardiac monitors require specific electrode placement. Orthogonal electrode pairs are essential for distinguishing normal sinus rhythm from ventricular tachyarrhythmia (VT/VF) in ambulatory monitoring.
Area of Science:
- Biomedical Engineering
- Cardiovascular Electrophysiology
Background:
- Developing subcutaneous monitors for cardiac arrest detection.
- Hypothesizing that electrode spacing impacts QRS amplitude detection during different heart rhythms.
Purpose of the Study:
- To evaluate the effectiveness of closely spaced bipolar electrodes for detecting ventricular tachyarrhythmia (VT/VF).
- To determine if orthogonal electrode pairs are necessary for sufficient signal amplitude to differentiate rhythms.
Main Methods:
- Studied 40 patients during ICD implantation.
- Used a 9-electrode array with 4-10 cm spacing, recording from peripheral electrodes referenced to a central one.
- Constructed 20 bipolar ECGs and measured QRS amplitudes in sinus rhythm (SR) and induced VT/VF.
Main Results:
- Optimal ECG amplitudes in SR did not always correlate with optimal amplitudes in VT/VF.
- Found that two orthogonal electrode pairs per patient provided sufficient QRS vector amplitude in both SR and VT/VF to separate rhythms.
Conclusions:
- A patient-specific set of bipolar electrode pairs can effectively separate SR and VT/VF.
- This approach is suitable for automatic rate-based separation in subcutaneous ambulatory monitoring.